Risk assessment of hypertension in persons with connective tissue dysplasia

Abstract

The aim of the study. To find out the features and risks of arterial hypertension (AH) stage II 1-3, combined with connective tissue dysplasia (CTD), based on the study of external and internal signs of CTD, indicators of free and total oxyproline, the results of instrumental research methods, consultations specialists and develop an algorithm for assessing the risk of hypertension in the presence of СTD. Material and methods. The study included 100 patients with stage II-3 grade AH combined with CTD, including 48 men (48%) and 52 women (52%). The mean age of patients was 59.72±2.42 years. The control group consisted of 30 people without high blood pressure and established CTD. Results. The frequency of detection of external phenotypic signs of CTD in patients with hypertension stage II 1-3 degrees was higher in group III compared with I and II, respectively. Among them were most often observed: atrophic stretch marks in the lower thoracic or lumbar spine; hemorrhagic skin manifestations; changes on the part of the nails (soft, brittle, lumbar striped); hair changes (thinning, fragility, dryness, slow growth); changes in the auricles, in the form of large protruding ears; changes in the musculoskeletal system (scoliosis, pain in the spine, transverse flat feet, valgus feet, macrodactyly of the first toe, «crunch» in the joints, the second toe larger than the first). Among the internal phenotypic features of CTD, most often registered in group III patients with hypertension stage II 1-3 degrees, compared with I and II, respectively. The following changes in the cardiovascular system were noted: additional chords of the heart, atrial fibrillation, varicose veins of the lower extremities of the mild degree; visual organs — retinal angiopathy; maxillofacial area — dental caries, periodontitis; gastrointestinal tract — dyskinesia of the biliary tract on the background of anatomical disorders (inflections); urinary system — dysmetabolic nephropathy, incomplete doubling of the kidneys. Increases in the concentration of free oxyproline in the blood of patients with stage II hypertension of 1-3 degrees, combined with CTD, were found in group I in 19 people (100%), in group II — in 31 (96.88%), in group III — in 47 (95.92%); increase in the concentration of total oxyproline in the first group of patients in 10 people (52.63%), in the second — in 25 (78.13%), in the third — in 45 (91.84%). Based on the scoring of the manifestations of CTD in relation to their prognostic value, an algorithm for assessing the risk of hypertension in persons with CTD has been developed. Conclusions. For the most common signs of CTD, a prognostic score on the risk of developing hypertension was determined. The sum of prognostic points determined for individual signs of CTD allows to predict the occurrence of low risk of hypertension 1 and 2 degrees when reaching 12 points, medium — from 13 to 19, high — from 20 to 29 and very high — 0 from 30 and more, respectively. For the development of grade 3 hypertension, patients with a score of up to 6, medium — from 7 to 14, high — from 15 to 19 and very high — from 20 and more, respectively, have a low risk.